Article Text

ESGO/ESTRO/ESP Guidelines for the management of patients with cervical cancer – Update 2023*
  1. David Cibula1,2,
  2. Maria Rosaria Raspollini3,
  3. François Planchamp4,
  4. Carlos Centeno5,
  5. Cyrus Chargari6,
  6. Ana Felix7,8,
  7. Daniela Fischerová1,2,
  8. Daniela Jahnn-Kuch9,
  9. Florence Joly10,
  10. Christhardt Kohler11,12,
  11. Sigurd Lax13,14,
  12. Domenica Lorusso15,16,
  13. Umesh Mahantshetty17,
  14. Patrice Mathevet18,
  15. Raj Naik19,
  16. Remi A Nout20,21,
  17. Ana Oaknin22,23,
  18. Fedro Peccatori24,
  19. Jan Persson25,26,
  20. Denis Querleu15,27,
  21. Sandra Rubio Bernabé28,
  22. Maximilian P Schmid29,
  23. Artem Stepanyan30,
  24. Valentyn Svintsitskyi31,
  25. Karl Tamussino32,
  26. Ignacio Zapardiel33 and
  27. Jacob Lindegaard34
  1. 1 Department of Obstetrics and Gynecology, Charles University, First Faculty of Medicine, Prague, Czech Republic
  2. 2 General University Hospital in Prague, Prague, Czech Republic
  3. 3 University Hospital Careggi, Firenze, Italy
  4. 4 Clinical Research Unit, Institut Bergonie, Bordeaux, France
  5. 5 Department of Palliative Medicine, University of Navarra, Pamplona, Spain
  6. 6 Service d’Oncologie Radiothérapie, Hôpital Universitaire Pitié Salpêtrière, Paris, France
  7. 7 Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal
  8. 8 Universidade Nova de Lisboa, Lisboa, Portugal
  9. 9 Department of Internal Medicine, Medical University of Graz, Graz, Austria
  10. 10 François Baclesse Centre de Lutte Contre le Cancer, Caen, France
  11. 11 Asklepios Clinic Altona, Hamburg, Germany
  12. 12 Asklepios Comprehensive Tumor Center, Hamburg, Germany
  13. 13 Hospital Graz II, Graz, Austria
  14. 14 Johannes Kepler Universitat Linz, Linz, Austria
  15. 15 Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
  16. 16 Catholic University of Sacred Heart, Rome, Italy
  17. 17 Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam, Andhra Pradesh, India
  18. 18 CHUV, Lausanne, Switzerland
  19. 19 Northern Gynaecological Oncology Centre, Gateshead, UK
  20. 20 Radiotherapy, Erasmus MC Cancer Centre, Rotterdam, The Netherlands
  21. 21 University Medical Center, Rotterdam, The Netherlands
  22. 22 Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
  23. 23 Hospital Universitari Vall d'Hebron, Barcelona, Spain
  24. 24 European Institute of Oncology IRCCS, Milan, Italy
  25. 25 Department of Obstetrics and Gynecology, Lund University Hosptial, Lund, Sweden
  26. 26 Skåne University Hospital Lund, Lund, Sweden
  27. 27 University Hospitals Strasbourg, Strasbourg, France
  28. 28 Medical Oncology, Clinica Universidad de Navarra, Pamplona, Spain
  29. 29 Department of Radiation Oncology, Medical University of Vienna, Wien, Austria
  30. 30 Gynecologic Oncology, Nairi Medical Center, Yerevan, Armenia
  31. 31 National Cancer Institute, Kiev, Ukraine
  32. 32 Medical University of Graz, Graz, Austria
  33. 33 Gynecologic Oncology, La Paz University Hospital, Madrid, Spain
  34. 34 Aarhus University Hospital, Aarhus, Denmark
  1. Correspondence to Dr David Cibula, Department of Obstetrics and Gynecology, Charles University, First Faculty of Medicine, Prague, 121 08, Czech Republic; dc{at}


In 2018, the European Society of Gynecological Oncology (ESGO) jointly with the European Society for Radiotherapy and Oncology (ESTRO) and the European Society of Pathology (ESP) published evidence-based guidelines for the management of patients with cervical cancer. Given the large body of new evidence addressing the management of cervical cancer, the three sister societies jointly decided to update these evidence-based guidelines. The update includes new topics to provide comprehensive guidelines on all relevant issues of diagnosis and treatment in cervical cancer.

To serve on the expert panel (27 experts across Europe) ESGO/ESTRO/ESP nominated practicing clinicians who are involved in managing patients with cervical cancer and have demonstrated leadership through their expertise in clinical care and research, national and international engagement, profile, and dedication to the topics addressed. To ensure the statements were evidence based, new data identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the international development group. Before publication, the guidelines were reviewed by 155 independent international practitioners in cancer care delivery and patient representatives.

These updated guidelines are comprehensive and cover staging, management, follow-up, long-term survivorship, quality of life and palliative care. Management includes fertility sparing treatment, early and locally advanced cervical cancer, invasive cervical cancer diagnosed on a simple hysterectomy specimen, cervical cancer in pregnancy, rare tumors, recurrent and metastatic diseases. The management algorithms and the principles of radiotherapy and pathological evaluation are also defined.

  • Cervical Cancer
  • Pathology
  • Radiation
  • Surgical Oncology

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Presented at These guidelines statements were jointly developed by European Society of Gynaecological Oncology (ESGO), European Society for Radiotherapy and Oncology (ESTRO) and the European Society of Pathology (ESP) and are published in the International Journal of Gynecological Cancer, Radiotherapy and Oncology and Virchows Archiv. The articles are identical except for minor stylistic and spelling differences in keeping with each journal’s style. Either citation can be used when citing this article.

  • Collaborators David Cibula, Maria Rosaria Raspollini, François Planchamp, Carlos Centeno, Cyrus Chargari, Ana Felix, Daniela Fischerova, Daniela Jahn-Kuch, Florence Joly, Christhardt Kohler, Sigurd F. Lax, Domenica Lorusso, Umesh Mahantshetty, Patrice Mathevet, Raj Naik, Remi Nout, Ana Oaknin, Fedro Peccatori, Jan Persson, Denis Querleu, Sandra Rubio, Maximilian Paul Schmid, Artem Stepanyan, Valentyn Svintsitskyi, Karl Tamussino, Ignacio Zapardiel, Jacob Christian Lindegaard.

  • Contributors The development group (including all authors) is collectively responsible for the decision to submit for publication. DC (chair), JL (chair), MRR (chair) and FP (methodologist) wrote the first draft of the manuscript. All other contributors have actively given personal input, reviewed the manuscript, and have given final approval before submission. DC is responsible for the overall content as the guarantor.

  • Funding All costs relating to the development process were covered from ESGO and ESP funds. There was no external funding of the development process or manuscript production.

  • Competing interests CCh has reported advisory boards for GSK, MSD and EISAI; SFL has reported advisory boards for MSD, GSK, AstraZeneca and Novartis; DL has reported consultant honoria from AstraZeneca, Clovis Oncology, GSK, MSD, Immunogen, Genmab, Amgen, Seagen and PharmaMar, advisory boards for AstraZeneca, Merck Serono, Seagen, Immunogen, Genmab, Oncoinvest, Corcept and Sutro, research institutional funding from Clovis Oncology, GSK, MSD and PharmaMar, research sponsored by AstraZeneca, Clovis Oncology, Genmab, GSK, Immunogen, Incyte, MSD, Roche, Seagen and Novartis, and speakers’ bureau activities for AstraZeneca, Clovis Oncology, GSK, MSD and PharmaMar; UM has reported advisory boards for AstraZeneca (Steering committee member for CALLA Study); RN has reported research grants from Elekta, Varian, Accuray, Dutch Research Council, and Dutch Cancer Society; AO has reported personal fees for advisory board membersip from Agenus, AstraZeneca, Clovis Oncology, Corcept Therapeutics, Deciphera Pharmaceuticals, Eisai, EMD Serono, F. Hoffmann-La Roche, Genmab/Seagen, GSK, ImmunoGen, Itheos, Merck Sharp & Dohme de Espana, SA, Mersana Thereapeutics, Novocure, PharmaMar, piIME Oncology, Roche, Sattucklabs, Sutro Biopharma and Tesaro, and personal fees for travel/accomodation from AstraZeneca, PharmaMar and Roche; DQ has reported advisory boards for Mimark inc; MPS has reported research grants and personal fees for workshops from Elekta AB; DC, MRR, FP, CC, AF, DF, DJK, FJ, CK, PM, RN, FPec, JP, SR, AS, VS, KT, IZ and JCL have reported no conflicts of interest.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Author note Initiated through the ESGO the decision to develop multidisciplinary guidelines was made jointly by the ESGO, ESTRO, and ESP. The ESGO provided administrative support. The ESGO, ESTRO and ESP are nonprofit knowledgeable societies. *These guidelines were developed by ESGO, ESTRO and ESP and are published in the Int J Gynecol Cancer, Radiother Oncol and Virchows Archiv.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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